Hepatitis is a family of several viruses, including Hepatitis A, Hepatitis B, and Hepatitis C that cause inflammation of the liver. This inflammation can lead to liver damage, scarring of the liver (cirrhosis), and increased risk of liver cancer in some patients.
Hepatitis A can affect anyone. Hepatitis A is spread through contaminated food and water, by transmission from feces to the mouth (for example, a person comes in contact with contaminated feces when changing a diaper, then unknowingly transmits the virus to his/her mouth), eating raw or partially raw shellfish that are contaminated, and other various accidental transmission from person to person. Hepatitis A can be prevented through vaccination, but it remains one of the most commonly reported diseases that are vaccine-preventable. Some people are at higher risk for infection with Hepatitis A; this include IV drug users/abusers, people who have blood clotting disorders or chronic liver disease, men who have sex with men, children who live in areas with high rates of Hepatitis A infection, and people who travel to other countries where Hepatitis A is more prevalent.
Symptoms of Hepatitis A
Adults infected with Hepatitis A may become ill very suddenly. The virus has an incubation period of 30 days, but an infected person can spread the virus to others up to 2 weeks before symptoms begin. Adults may experience fever, nausea, vomiting, fatigue, jaundice, pain in the stomach area, and discolored urine (dark in color) and stool (light in color). Children with Hepatitis A usually have no symptoms. Symptomatic adults will have symptoms that disappear over 6-12 months or until complete recovery from the virus.
Treatment of Hepatitis A
There is no specific treatment needed for Hepatitis A infection. This virus will be cleared by the body over weeks or months, and there are usually not any serious lingering effects from the infection.
Hepatitis B (HBV)
HBV affects many people, including 1 out of 20 adults in the US in their lifetime. HBV causes inflammation of the liver and often liver cell damage that can lead to cirrhosis and liver cancer in some individuals. HBV spreads through contact with infected blood or body fluids and from mother to baby. Some people are at increased risk for developing HBV infection. These people include men/women whose sexual partner has HBV infection, men who have sex with men, those who have multiple sexual partners, those living in the same household has a person with chronic HBV infection, illegal IV drug users, those who have contact with blood through their work, people with hemophilia, and those who travel to areas with high rates of HBV infection (areas with high rates of HBV infection include all areas of the world except for Australia/New Zealand, northern and western Europe, all of North America except Mexico, and Japan). HBV vaccination can protect people from HBV infection, and vaccines are now routinely given to all adolescents and children. Individuals at higher risk for HBV infection should also be vaccinated.
Symptoms of HBV
Many people have no symptoms of infection when they first become infected with HBV, or people may suffer flu-like symptoms that are mild and include low-grade fever, nausea, decrease in appetite, fatigue, achiness, and sometimes jaundice (skin looks yellow, as well as the whites of the eyes). The only way to be sure that you are infected with HBV or carry the virus is to have a specific blood test for HBV (HBV may not be tested during routine blood work). Some blood tests show that you have infection now, some show that you have had infection at some point in the past, and some blood tests show that you are immune to HBV (those who have been vaccinated for HBV have immunity to the virus). The tests for HBV may show up as negative when the virus is in its incubation period (which lasts for 45-180 days).
Treatment of HBV
Some adults (around 95% of those infected) develop antibodies to HBV and recover from the infection on their own. After these adults recover, they are no longer contagious to others but still test positive for the HBV antibody. The remaining 5% of those infected with HBV are considered to have chronic HBV and to be carriers (those who are not free of the virus after 6 months). Chronic HBV patients/carriers are contagious to others but may not have any signs or symptoms of infection.
There are several medications used to treat chronic HBV infection, Interferon (IFN), Entecavir, Tenofovir, Telbivudine, and Adefovir and Lamivudine. IFN treatment has many side effects that may be difficult for patients to tolerate, including flu-like symptoms, fatigue, decreased appetite, nausea, vomiting, diarrhea, headache, and thinning hair. IFN also may decrease the body’s production of some blood cells, including white blood cells and platelets, because it depresses function of bone marrow. Patients that are being treated with IFN must have blood tests performed to monitor their blood cells (including platelets) and their liver enzymes. Speak to your doctor to see which treatment plan is best for you.
Those infected with HBV should be vaccinated against Hepatitis A as well. There is no treatment for acute HBV infection.
Hepatitis C Virus (HCV)
HCV virus causes inflammation of the liver, and over 1.8% of Americans has been infected with it. Some people clear the virus on their own (about 15-25%), and others develop chronic infection. Chronic infection with HCV is often asymptomatic, and HCV infection progresses very slowly, with serious liver damage taking 10-40 years to occur. People should have blood tests for HCV infection whether they are at risk for HCV infection or not. An individual may have no clear signs or symptoms that they are infected with HCV, and there are many people in the US who are infected with HCV and most do not know they are infected. Around 10% (or 1 out of 10 people) of those with HCV infection do not have any recognizable exposure or risk factor for HCV, but there are risk factors that increase the chance that someone will become infected with HCV. HCV is passed through blood and body fluids, notably through needles, but not through casual contact (like kissing). Those at higher risk for HCV infection include those who have used IV drugs at any time in their lifetime (even a long time ago), those with high risk sexual behavior (like multiple sexual partners, sexual partners with other sexually-transmitted infections, etc), patients on hemodialysis, any object (like razors, scissors at a hair salon, nail files, toothbrushes, and needles of any type- from tattoo and body piercing equipment to acupuncture and those needles used in the healthcare field) that becomes contaminated by blood or body fluids of an infected person, and sometimes from mother to child (though this rate appears to be 5%). Transmission from blood transfusion is very rare at this time, but those who received blood transfusions or clotting factors that were produced prior to 1987 are at high risk. Healthcare workers have a 2% chance of infection after a needle-stick from a contaminated needle.
Hepatitis C Symptoms
Since most individuals that are infected with HCV do not have symptoms, blood tests are very important for diagnosis. If symptoms are present, they are usually mild and flu-like (nausea, low fever, fatigue, decrease in appetite, abdominal pain, etc). Most people with HCV do not have jaundice, but sometimes it does occur; dark urine can also be present. The virus incubates over 2-26 weeks, but liver enzyme tests may be normal. If liver enzymes are elevated, they can stay that way for weeks or up to a year. Whether a person has symptoms or not, if he/she has the HCV in the blood, it can cause liver damage and is contagious to others.
Treatment of HCV
- Depending on the genotype of HCV, there are several different treatment options available. Until the past few years only three types of interferon, as well as a combination of Ribavirin and interferon, were used to treat HCV. However, new treatments Victrelis (Boceprevir) and Incivek (Telaprevir) were released in 2011, and in 2014 the newest treatments Sovaldi (Sofosbuvir), Olysio (Simeprevir), Harvoni (Ledipasvir and Sofosbuvir), and Viekira (Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir) were also released.
With these newer developed therapies cure rates and side effect profiles are improving outcomes for HCV patients. Many of these drugs do have extensive side effect profiles, contact your health care professional for a complete list of what to expect while taking these medications. Other new drugs are currently in the pipeline to be released in the next year, so treatment regimens are expected to improve in the future as well.
Today, almost half of all liver transplants are performed on end-stage HCV patients, though the transplanted liver is likely to be infected as well after transplant. HCV patients should maintain a healthy diet and normal activities but should be aware of activities that are physically exhausting, stressful, or depressing. Prevention and education to prevent transmission to disease-free individuals are both very important.
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